Dellon Institute TutorialPosted by arnold on 5/17/05 at 08:55 (175176)
at DellonIPNS.com there is a tutorial on the home page with excellent illustrations of the need to decompress four , not just one tunnel on the inside of the ankle region. And there is a brochure, Tarsal Tunnel Syndrome that explains the way Dr Dellon does the surgery and the recovery process. This is the way to go.
Re: Dellon Institute TutorialDebbie on 5/17/05 at 13:46 (175188)
I can't seem to get on this website. The page will not load.
Re: Dellon Institute TutorialDebbie on 5/17/05 at 16:08 (175200)
OK, got it to finally come up and to my surprise, my doc is one of the ones listed. Wow, that is weird as I was wanting to get a 2nd opinion from his institute. Thank you for the link. This is the doc that told me, I'd be back to work on my feet walking on concrete after 3 weeks from having TTS surgery.
Re: Dellon Institute TutorialEd Davis, DPM on 5/18/05 at 12:17 (175245)
3 weeks is a bit quick to be comfortable on concrete -- did he mean walking on concrete for 15 minutes or a full day of work on concrete?
Re: Dellon Institute TutorialDebbie on 5/18/05 at 12:41 (175247)
You know, I don't know, but when I go for my next appt, I am going to ask. This site is sure helping me alot. Please help me know what questions to ask him. Dr. Ed, I am in so much pain, I am not sure I can continue my job and it is scareing me to death. I need to work for finacial reasons, but the job I am at is killing me. The neurontin is making me all foggy also. I am up to 2100mgs. I need help but don't know what to do. Thanks Dr. Ed for your advice, I need it.
Re: Dellon Institute TutorialEd Davis, DPM on 5/18/05 at 15:53 (175260)
Tarsal tunnel syndrome may be caused by somethiing placing pressure on the nerve and removal of that can be helpful or it may be caused by excess scar tissue. If it is the latter, it may be helped by injection with lidocaine, hyaluronidase and a small amount of cortisone. Read through posts on this board and use the search feature as these modalities have been discussed fairly often. The injection would be much, much better for most people than all of the neurontin you are taking.
Re: Dellon Institute TutorialDebbie on 5/18/05 at 16:05 (175264)
I have Diabetes, have had it for almost 30 yrs, I will be 50 this summer, I of course take insulin. I think TTS is common in diabetics but I am not sure. All I know is I am in a lot of pain, and need some relief. Do you ever take someone off work for this before surgery? What other methods do you use? Casts etc, before surgery?
Re: Dellon Institute TutorialEd Davis, DPM on 5/18/05 at 19:43 (175283)
Diabetics can get nerve damage called peripheral neuropathy so the first thing you need to know is how much of the symptoms are from the diabetic neuropathy and how much from tarsal tunnel syndrome. A qualified neurologist or physsiatrist should perform a nerve conduction velocity test (NCV) to help determine that. Keep in mind that TTS only affects the bottom of the foot while diabetic neuropathy affects top and bottom.
German Commission E research has shown that 800 mg. per day of alpha lipoic acid (available at many pharmacies and health food stores) will make a big difference in diabetic neuropath in 3 to 4 weeks so I would definitely give that a try first. Second, many conservative treatments exist.
One conservative treatment includes injections of a scar dissolving enzyme, hyaluronidase, about the posterior tibial nerve. Other modalities include interferential therapy, phonophoresis and iontophoresis -- all physical therapy modalities.
Re: Dellon Institute TutorialDebbie on 5/18/05 at 20:56 (175289)
I had the PSSD test done and it showed severe nerve compression. Not sure what that means. Yes I do have neuropathy, I know that. The doc was talking about cutting me in 3 places, one on the ankle, one on top of my foot and the other right below my knee. Does this sound right? I will give the alpha lipoic acid a try. Thank you. What is a physsiatrist? I have a appt with a pain mgt clinic next week, but am thinking of postponing it. What you think? Thanks.
Re: Dellon Institute TutorialDebbie on 5/18/05 at 21:16 (175293)
800 mgs or 80 of ALA?
Re: Dellon Institute TutorialMike on 5/19/05 at 00:38 (175306)
I had release surgery by Dr Dellon in Jan. 2004. Sounds like the exact thing you are about to go through. I had about a 3' incision on my ankle over the tarsal tunnel, a 2' on top of my foot and a 4' cut just below and to the outside of my knee. I dont remember all the nerves but there were alot.
This is how it was explained to me - being a diabetic myself:
Tarsal tunnel is when the nerves are compressed from the outside in - either an accident, scar tissue or similar can compress the nerves and cause the damage.
Diabetic Neuropathy is sort the opposite but you end up with the same result. In diabetics, the extra sugar in the blood is converted to sorbitol (whatever that is???) anyway, it causes the nerves to swell. So now you have larger nerves trying to fit through the same size tunnel and therefore, the compression.
I always thought of nerves as tiny little things but Dellon said my nerves were about the thickness of a pencil!
Anyway, not to scare you away but after surgery I was completely pain free in both feet (I only had one side done mind you) for about 2 months. It was wonderfull - until the pain came back. A year and some months later Im still in pain but was finally given accurate pain control so I have somewhat of a normal life.
BTW - Im 35 and have only had Type 2 since 2001. I dont take insulin or any drugs for it as it's all controlled by diet and excercise.
I hope everything works out for you. No one deserves to go through this pain.
Re: Dellon Institute TutorialEd Davis, DPM on 5/20/05 at 12:56 (175365)
Dr. Dellon beleives strongly in PSSD although that modality is not generally accepted so it is a hard call. There is little harm to giving the conservative route a chance. One can be agggressive with conservative treatment.
Re: Dellon Institute TutorialMike on 5/20/05 at 13:18 (175369)
I had the PSSD test done also - didnt seem too technical to me. It has 2 prongs and they press it on your skin and you press a button when you feel it. Its supposed to measure the pressure applied and calculate it with your responses and spits out some results.
Dr Dellon actually developed the PSSD system.
Re: Dellon Institute TutorialDee on 5/20/05 at 14:00 (175372)
My PT tells me that 2-point discrimination has been used for a long time. PSSD is a more formalized approach using a computer to track the results. Basically the further apart the prongs need to be set for the patient to be able to feel each probe separately, the more the nerve damage. Of course, it doesn't necessarily mean that surgery is in order.
OTOH, if a standard NCV test is positive, the nerve problem may be more serious. Also, beware of assuming a negative result = no nerve problem.
Re: Dellon Institute TutorialDebbie on 5/20/05 at 20:42 (175395)
I am in so much pain tonight, I can hardly stand it. I of course worked all day on my feet and have to do it agin tomorrow, I was in near tears all afternoon, which is so unlike me. I can usually take pain , but this is unbearable. I don't know what to do. We all need relief from this. I am sorry folks, I just needed to vent to someone who understands. Thanks for listening. The neurontin is doing no good, I don't kow what to do next.
Re: Dellon Institute TutorialEd Davis, DPM on 5/24/05 at 18:01 (175652)
Dr. Dellon is convinced that a decrease in the ability to distinguish between two points (two point tactile) is the best test for TTS. Mohammed Saeed, MD, who I consider the best NCV performer in the US, owns a PSSD but respectfully disagrees with Dellon on that point.
Re: Dellon Institute TutorialDee on 5/24/05 at 18:05 (175654)
That is very interesting. I had the PSSD which showed more nerve issues than I have symptoms for and the 2 NCV tests showed nothing. The PSSD even showed the need for a peroneal nerve release, but I don't have any problems there.
Do you have contact info. for Dr. Mohammed Saeed?